Significant Event Audit or Analysis (SEA)
Definition
Significant Event Audit or Analysis (SEA) is a formal process used to reflect on and learn from cases in practice, in order to improve care.
This involves a practice discussion and completion of formal minutes summarising the discussion.
The RCGP suggests that an SEA template could include:
What happened and why?
How could things have been different?
What can we learn from what happened?
What needs to change?
What was the impact was on those involved (patient, carer, family, GP, practice)?
How often should there be a SEA?
NHS Improvement advises that primary care teams meet regularly (at least every other month) to consider new events and to ensure the actions from previous SEAs have been implemented. The RCGP suggests meeting every month.
CQC and SEA
Before an inspection, the CQC will request a summary of any serious adverse events, any action taken and how learning was implemented.
The CQC has indicated there should be a minimum of two SEAs per practice with a focus on quality improvement.
It warns that a practice that has done no SEAs is likely to be a cause for concern.
SEA is also a key component of the NHS GMS (General Medical Services) contract.
Sharing learning outside the practice
Sharing what's been learned is encouraged outside the practice as well as internally, so that patients can benefit from the lessons across a larger practice base. Where patient safety has been (or might have been) compromised the CQC expects practices to report incidents to the National Reporting and Learning Service (NRLS). NHS England has devised an online form for general practice staff to report patient safety incident reports. This can be done anonymously by the practice, or the practice code can be provided: Patient Safety eForm.
The practice could also consider sharing lessons with other practices in the area, such as those in the local CCG.
SEA analysis of a hypothetical case of missed lung cancer in primary care
How does the patient's presenting symptoms and on-going management compare with best practice (NICE or BTS guidelines) given the patient’s age, persisting cough, and requirement for antibiotics?
Were there any other Red Flag features in the patient’s medical history (such as weight loss, ex-smoker status) elicited by the doctors and appropriately recorded and acted upon?
Were the treatment decisions (1st, 2nd, 3rd course of antibiotics, Chest X-ray following third unsuccessful antibiotic course) appropriate?
What safety-netting instructions were provided to the patient and were these appropriate?
According to best practice and national guidelines, was there a delay in requesting a Chest X-ray investigation?
Apart from the clinical decision to request a Chest X-ray, were there any other factors contributing to the delay in completing the investigation and receiving the radiologist report of malignant lung lesion and promptly referring to Respiratory Oncology team (such as electronic requesting, hospital scheduling investigation, patient transport, patient attendance, radiologist reporting delay, receiving radiologist report to the practice).
To what extent did the delay in diagnosis adversely affect the stage and prognosis for the lung cancer (may require expert opinoin from Consultant Respiratory Physician)?
Are there things that individuals or the practice as a whole will do differently for patients presenting in a similar way in the future?
Are changes needed to any practice protocols and procedures for cancer diagnosis and/or referral to improve patient care?
Are there personal or practice-based education and training needs around lung cancer diagnosis and referral?
If so, who does the learning apply to, and how will learning needs be addressed (for example, online modules, courses, or a specialist talking to the practice)?